Sex differences were apparent, with men performing better than women without the aid of photographs (Table 3). However, women had a higher sensitivity and specificity of SSE with the use of photographs compared with men. Results showed that patients with more than 5 moles altered or created had significant improvements in diagnostic accuracy with the aid of baseline photographs, although patients with 5 or fewer moles altered or created still gained some benefit from access to photography (Table 4). The stratified analyses suggested that patients with fairer complexions (eg, light skin, eye, and hair color, tendency to burn, and ability to tan) had higher sensitivities both with (76.6%, 82.8%, 79.8%, 76.0%, and 78.7%, respectively) and without (59.9%, 70.5%, 67.5%, 60.5%, and 61.9%, respectively) the aid of photographs compared with patients who did not have these risk factors (with photography: 62.9%, 66.0%, 68.3%, 54.7%, and 66.5%, respectively; without photography: 60.8%, 53.8%, 56.1%, 58.4%, and 58.5%, respectively). There were no similar trends in the analyses stratified by family history of skin cancer or SSE practices. However, patients with a personal history of melanoma had higher sensitivities both with (80.0%) and without (65.8%) the aid of photography compared with patients with no such personal history (with photography: 67.8%; without photography: 56.8%).